Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A39721 | CA |
NPI | 1568449122 |
---|---|
Provider Name | Dr. Shirley Rachel Korula |
First Address | Los Angeles, CA 90032-4220 |
Second Address | Los Angeles, CA 90032-4220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A85325 | (02) |